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2015-200 41111a. TOWN OF QUEENSBURY Forg742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20150200 Date Issued: Thursday, June 04, 2015 This is to certify that work requested to be done as shown by Permit Number P20150200 has been completed. Tax Map Number: 523400-315-005-0001-002-000-0000 Location: 43 WEST MT. Rd Owner: MICHAEL & MICHELLE BARBONE Applicant: MICHAEL & MICHELLE BARBONE This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the 4714 property owner of the responsibility for compliance with Site Plan, �,Yf Variance, or other issues and conditions as a result of approvals by the Director of Building&Co e Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 0^, 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 I OS I Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150200 Application Number: A20150200 Tax Map No: 523400-315-005-0001-002-000-0000 Permission is hereby granted to: MICHAEL& MICHELLE BARBONE For property located at: 43 WEST MT. Rd in the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: MICHAEL& MICHELLE BARBONI Septic Alteration Residential 43 WEST MT. Rd Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency IBS SEPTIC & DRAIN ATTN: IVAN BELL 2 LOWER WARREN St OUEENSBURY.NY 12804 Plans&Specifications BP 2015-200 Residential Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, May 27,2016 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Tow ueensb ; d fr.sd. , May 27, 2015 i SIGNED BY 41 for the Town of Queensbury. Director of Building&Code Enforcement s�F?. 'Y3.,ty eve!o- nt Office DI ,Town of Queensbury ti,1 • Bay Road a Queensbury, New York =128041 r.., , Office Use OnlyMAY 2 6 ZUV3 TAX MAP NO. 1' ' •iU�Fh1SBUF''' PERMIT NO. ���'` PERMIT FEE APPROVALS: ZONING ^ ? ''ODFTOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: I ( \ \� yi ;/'�o Y1� INSTAL I FR: ISJ 5 € p t I C ADDRESS: 3 \N ,S V` . fkd' ADDRESS: \O w l W U i r 1 S j` PHONE NOS. b \ —L \ C PHONENOS. 7 9 , 3 `��/ LOCATION OF INSTALLATION: Li e J P�� c,. ` RESIDENCE INFORMATION: YEAR BUILT NO.OF X I COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRI[ FR �1D 1980 or older X 150 = 1 41 (j INSTALLED? NN 1981-1991 I V� X — 130 = I V N SPA OR HOT TUB 11992-present 'v I ` X 110 v Lk- INSTALLED? it( ('` PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT RO ING \ STEEP SLOPE Nle %SLOPE \V ✓ SOIL NATURE: SAND J LOAM CLAY „' OTHER \V 11— ✓ GROUNDWATER N AT WHAT DEPTH? N \q r ✓ BEDROCK/IMPERVIOUS MATERIAL: AT W7i- v DEPTH?I\�"J(!!!\liV DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft) '� J l• ' ✓ PERCOLATION TEST: RATE IS V PER MIINUTE PER INCH[mpij (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). TANK SIZE: ICI eiC) GALLON (MIN.SIZE IS 1.000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirl of tub. SYSTEM PE: �--{� SORPTION FIELD(WITH NO.2 STONE) Total length-).--00 ft_ Each trench I x 5 `+J ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? V Size? l V h. o ALTERNATIVE SYSTEM Bed or other type? �( ❑ HOLDING TANK SYSTEM Total required capacity? NTank size? \\I \--\\ Number of tanks? \`I l� NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY_ PLEASE REVIEW LIST PROVIDED. For your protection,please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or circumstance known by or on behalf of an applicant,shall be void. I have read the regulations with respect to this application and agree to /// 1' abide by these .••. - requirements of the Town of Queensbu (QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Se ; • •••osal Ordinance. ���/ 1 coclesna cueensburv.nee Signa on Responsible Date 9� I VISIT OUR WEBSITE FOR MORE INFORMATION Jwi.Rftr.oueensburv.:Ka Town of Queensbury Building & Code Enforcement Office No. (518) 761-8256 1 Septic Inspection Report Inspection request received: 5'211 1� Name: 1 :llbpycj Inspected on: '(n, \ 1`J Location: ,zt m- • 1La• Arrive: a.m./p.m. Permit No.: 15-Zoo Inspector's Initials: --4 Comments and/or diagram 1 Soil Type:644Lo lay Type of Water: unicipal ell Water Waterline separation istance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total length j,ai ft. Length of each trench !ate ft. Depth of trenches 2 ft. Size of Stone e Seepage Pits: Number 0/✓A- Size: x Stone Size: Piping Size Type Ai Building to tank `s 1 Tank to Distribution Box . -SliR, 35" Distribution Box to Field/Pit 4Alit.k STIR- 3 ç' 4- Opening Sealed: N End Cap N Inlet/Outlet Pipes&Baffles Vr_N Manholes 12"or less below grade Y [provide extension collar if Yes] Y III Pt Location/Separations Foundation to tank 10 ft. Foundation to absorption 2£5-6 ft. Separation of Pits PIA- ft. Conforms as per Plot Plan / N,, Engineer Report and As-Built Y ETU Maintenance Contract provided Y N Location of Systerrri'Pr perty: Front Rear Left Side Right Side Middle Front Middle Rear System Use Stat,_ //.prove. Pa ial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report i 1 1 i I I - -' _ I I ��l 1 E 1 l i ? f 1 I j i I I 1 1 1 .1 1 - L :1 , 4 - , --I 1 I 1 I i j i--1 _-+__.N ._�-. -k, -- 1--; Michelle Barbone BP 2015-200 I l— - ' 115 . - 1 � -4---i ! 43 West Mountain Road i_____,_1 ' 1 I 1- • Residential Septic Alteration Tlovvc� o Q -E 1 BURY.. . . P ' t ! '; BIJILCitliCa4_CO_DES : t_ i , I 1 i I 11 l 1 • 1 - I I r r° ; I I i • I 1 I I I- i 1 i I i i- If I i 'L I I 11 1 I i I I Ii I -T 1 � , 1 -- I i j i 1 I I ! � 1 Ir. T U E 1 ✓ 1 , i I � ! � Iii, NIOFQ � , y I I I � l � I BUI . DI\I rig-4 s� , �i , - I • ' I j �;r , ' I Reviewed By ;ai' ; 11 � 1 I Dati — • I I 1 I; 1 j 1 I - - • I l II i I I I — — -- ; , : I i , 1 '1 , ; ; i ; , ,.. ii , , ; .; 1, , , __. : ; I ( I . , 11 1 1 I I I I ' 1 1 � , I _I I I I i1 I I I 1 1 I I I 1 ` 1 I I I I• ' •1 I l i f I I I I ! 1 I ---'- -I - i I •I 1 1 ( •1 1 i I I 1 1, I 1Il 1 I I 1 1 I 1 , I I G 1 i I I ' -- - i I i -'I ; I I � 11 I ; 1 1 : H- H I I 1 I I I I i I 1 -- , $J� ! I I, 1 1 �'. i 1 1 I y I . 1 1 IH I - - I 1 I 1 ' 1 ! '1111, 111 '1111 I 1 1 111 11 1 1J 1 I i I- I I 1 1. I I 1 -- , : .--1 , , , , , , , , , , , , , , 7 1 ill - . . 1 I 1 I I 1 1 I II I I , I1 ! 1 Vi! : )•••' I ! f - - II ' III-1IIIII I 1i Iilli1lil11I111II . l